Dr Samyukta Mullangi Talks Cost Reductions, Scalability of Thyme Care's Navigation Program

Samyukta Mullangi, MD, MBA, medical director of oncology at Thyme Care and medical oncologist at Tennessee Oncology, goes into detail about the reduced per member per month costs for Medicare Advantage members with cancer who used Thyme Care's navigation program, and the scalability of these findings across contracts. Mullangi sat down with The American Journal of Managed Care® (AJMC®) to further discuss these findings following her panel at the 2023 Patient-Centered Oncology Care® (PCOC) meeting, “Building Trust: Tools and Strategies for Patient Engagement."

Samyukta Mullangi, MD, MBA | Image credit: X

AJMC: The study mentions that Thyme Care's virtual navigation program resulted in a $594 reduction in total costs per member per month for navigated patients compared with a control group. Could you provide more context about the initial cost of care for patients with cancer and how this number compares with other care navigation approaches?

Mullangi: First, I'll describe why I think this navigation approach is unique, so answering your second question first. Thyme Care is a technology company that basically creates a clinical care team potentiated by purpose-built technology in a curated provider network to try and enable value-based care. And the interesting thing about our solution is that it's a patient navigation first solution, but it is delivered by a team that is entirely virtual, and that's a third party. That's because you'll see in the literature a lot of navigation cost of care outcomes and things like that reported, but oftentimes those solutions are housed and developed and launched within the context of a provider system. You'll see Duke University has a navigation program or a certain provider network on the west coast has a navigation program. But you rarely see these types of programs that are put together by a third party and, to the point of this panel [presented at PCOC], I think there's a different element of trust-building and engagement, and I think those types of strategies are so much more important in this context.

[At PCOC] we presented data that we actually presented at ASCO Quality in Boston just recently, and it's a difference-in-differences analysis of members who are all enrolled in the same Medicare Advantage plan, some of whom voluntarily enrolled with the Thyme Care navigation program, and others didn't and those guys formed our control cohort. Everybody has a cancer diagnosis and is on active therapy, and we match these patients on both their diagnosis as well as their acuity level, which is an operational decision that we actually make in the company for every patient, whether they enroll with us or not. An acuity level is something that we use to risk stratify our patients and determine sort of the cadence of outreach that we will then deploy to them. I think we enrolled 460 members in this study, and they collectively contributed over 3000 months of data. What we found is that in the navigation group, we actually saw about a $300 reduction in the total cost of care, something like $3000 at the benchmark to $2700. In the control group, we actually saw a $300 increase in the total cost of care, and this is on a monthly basis. Put together, that difference-in-differences analysis comes to just shy of $600 per member per month.

Like we expected, the majority of this—70% of it—came from reduced acute care utilization costs, so costs associated with hospitalizations, mostly. There was also a small signal with reduced costs related to laboratory spend and radiation spend, but on a magnitude perspective, they were much less. It kind of makes sense, because I think of our intervention as being symptom management, care coordination, patient education, addressing social determinants of health. A large part of our intervention is around keeping people functional and comfortable, and not ending up in a hospital in sort of an unexpected way. So, I think that thesis was born out and it's just very exciting to see. I will also add that this is the second time we've demonstrated this. Before I joined the company, this team presented data that was a propensity-matched cohort analysis—also presented at ASCO Quality, it was a podium presentation—using a different time period of analysis and a different analytic method, but they showed pretty much these outcomes. I think that's pretty exciting, because it shows that this is an intervention that wasn't just a fluke, it's something that we're consistently demonstrating year after year using different time periods, different populations, and using different analytic methods.

AJMC: What are some key factors that you think contributed to these cost savings?

Mullangi: I think the components of our intervention that were most effective here were symptom management, care coordination, addressing social determinants of health and doing patient education. We [on the panel] also divided our outcomes and looked at these process measures to try and create a story about what it is that we did that led to these outcomes. We can see that our teams generally interacted with patients about a little short of 3 times per month, which is actually a pretty large cadence of interaction. And then we have components of like, what did you guys talk about in each interaction?

For example, about 60% of patients reported a social determinants of health need—whether that's food insecurity, transportation difficulty, language barrier, or just cash flow issues—and we see that over 80% of the time, they were connected with a resource that was helpful. A good 50% of our patients were speaking to our nurses on an educational capacity, so talking to patients about their diagnosis, their treatment, answering questions about these treatments, symptoms that are expected vs unexpected, when to call the physician, things like that.

A large part of our effort is around care coordination, especially when folks are, for example, coming out of hospitalization or if they're reporting a very acute symptom when we're asking about symptoms, that we are connecting them to a physician visit or looping in their oncologist, making sure that everybody is in a closed loop communication. [Also] helping patients secure appointments across the network. For folks who wanted a palliative care appointment, if they wanted a geriatric assessment, if they needed psychological help, connecting them to a psychologist that was covered by their insurance. That type of care coordination is also something that we worked on a lot. I think it makes sense that we're seeing like 70% of these averted costs are related to averted acute care utilization. I think that story is very cohesive.

I will say, the thing about a startup is we have interventions that stand up over time as we kind of develop our product and we go about our work. For this project, the study period ended earlier this spring, I think it was March 2022 to February 2023, and that was around the same time that I joined the company. And I will say, even in the last like 8 months, we have stood up so many more work streams. We're thinking all the time not only about how do you refine existing interventions, but how do you support them with an even broader kind of scope of work? I'm excited for the next time we repeat this study, because I really think that I expect that the magnitude of savings that we've demonstrated here should only grow, and I'm excited to share the world that as well.

AJMC: The study focused on a collaboration with a Medicare Advantage health plan. How transferable are the findings and strategies to other health care providers and payers, and how scalable is this independent virtual navigation model?

Mullangi: I think it's really scalable. When you think about the focus on quality and cost of care in a value-based care context, Medicare Advantage plans come to mind because Medicare Advantage is inherently a value-based care program in the sense that plans are getting paid in a capitated fashion by the government, and then they then have to allocate their dollars to try and keep folks healthy and doing well in their communities. But at the same time, those are not our only partners. We also have live contracts with commercial partners; we are working with the American Oncology Network, which is a large oncology provider practice that is participating in the Enhancing Oncology Model, so that's a Medicare fee-for-service value based care model. And then we have a few other exciting announcements that we will probably share towards the end of this year [2023].

What I'm trying to say here is that our model is scalable across a variety of different contracts, whether that is with a payer, both governmental and commercial insurers, or provider networks. I'm energized by that, because it shows that there are nuances to what you can do in different populations and the needs of different populations—Medicare age needs vs a commercial population, etc. But there's a way to adapt what we're doing, and I think we're demonstrating that there's value across all of these different populations.

AJMC: Could you elaborate on the potential challenges and opportunities in deploying such independent navigation programs in a health care landscape transitioning to value-based care arrangements?

Mullangi: I think there's actually probably more of an opportunity than a challenge, but I'll speak to both. The opportunity is that, when I think about what is wrong with health care today—the fact that it's so reactive, that it's not seamless, it's not connected—things like navigation, which are great and can help so many patients who don't have a billing code associated with them, so in a fee-for-service context you don't know how to pay for that necessarily outside of a grant program, all of these things kind of impede the ability to deliver the type of care that we as physicians want to give our patients.

The nice thing about the Thyme Care solution is that it's truly scalable. And in a way that a lot of these programs, even when set up across pockets of different areas across the country, they're not necessarily scaling in the same way. And I think it's because they're challenged by capital issues, they're challenged by a lack of a business model that works, they're challenged by the fact that maybe there are not clear best practices. A lot of the solution also involves upfront investments. It's not enough to just hire a few navigators and say, "go do your work." There are training programs involved, and there's technology that they require to really effectively do their job.

So all of that requires just a tremendous amount of work and energy. I think that what we're building here is something that could benefit huge populations across the country, in different contexts, and supported by a model like a business model that actually works and that is sustaining, and it's not a one-off kind of a grant program. I think all of that is really energizing. And when I think about the fact that I—also a medical oncologist—treat patients, I have that perspective constantly when I'm in wearing my Thyme Care hat. And I just think to myself, what is it that I would need as an oncologist, or what are ways in which I would want to keep myself in the loop if I was on the other end of this?

I enjoy the work a lot, I really do believe in the company, and I think we're doing really good work. I think the challenges are that what we are offering to some extent is a great solution, but it's still one that is working in the context of a very broken, fragmented health care system. So, as much as I think we are pulling together the different strings to try and create a better outcome and a better solution for our patients, we're still operating in that kind of disconnected global ecosystem.

And so I think we're always confronted with real life challenges and inequities that exist, as much as we try and paper over them. For example, I was recently talking with our care team about patients in a certain geography who are demonstrating real needs in terms of transportation difficulty, food insecurity, etc., and we're trying to connect them with resources, but then recognizing that locally those resources just don't exist. Local communities have not made those investments, and there are no nonprofits, there's no state-supported food banks, etc. And we're also kind of at our own wits end trying to understand what resources can we bring to bear, because we're still operating in the context of a system that is just fundamentally broken.

So, at the same time, I feel optimistic, because I think what would it look like if we weren't even here, and it would be that much worse. I think it gives me energy and hope more so than it frustrates me to look at what's going on, but I think that because we know we're in this context that hopefully patients are better for it.

This transcript has been lightly edited for clarity and conciseness.

Reference

New data shows Thyme Care navigation program reduces total cost of care for cancer patients by nearly 20%. News release. PR Newswire. October 31, 2023. Accessed November 7, 2023. https://www.prnewswire.com/news-releases/new-data-shows-thyme-care-navigation-program-reduces-total-cost-of-care-for-cancer-patients-by-nearly-20-301972537.html